Wire Transfer Domestic Authorization

Authorization for Domestic Wire Transfer

The deadline for same day processing of a domestic wire transfer is 2:00 p.m. ET Monday through Friday

Wire Transfer Amount *

Purpose for Wire *

By order of:

Originator Name *

Contact phone number needs to be the same one that is on your Membership for at least 30 days

Daytime Phone *

Address (Street) *

Address (City) *

Originator Member # *

Suffix/Account # *

Amount to be wired to the following Bank or Credit Union:

Bank or Credit Union Name *

Bank Address Street

Bank Address City

ABA #, Swift Code, Sort Code *

For further credit to the brokerage firm, or other financial institution (leave blank if not applicable):

Institution Name

Institution Address Street

Institution Address City

Account #

For final credit to:

Beneficiary Name *

Beneficiary Address Street

Beneficiary Address City

Account # or I.D. # *

Special Instructions (leave blank if not applicable)

I hereby authorize Success CU (the 'credit union') to execute the above wire transfer and will debit the above mentioned account (originator) for the above amount plus a fee of $25 Domestic. The originator agrees to hold the credit union harmless from damages caused by negligence or instructional errors of parties to such a transfer. Request for reversal or retrieval of any wire transfers will be credited back to the originator upon receipt of such funds. The credit union will make reasonable efforts to obtain such reversal. It is understood the credit union will exercise careful due diligence in carrying out the instructions, however it is understood that is no actual guarantee as to the arrival times for any specific wire transfer and the Credit Union is not responsible for any fees assessed by any forwarding financial institution.

I understand I will be contacted by a credit union representative for verification purposes regarding this wire transfer, at the phone number listed on my membership. This wire will not be sent until I am contacted and verified.

All Wire Transfers are subject to review in accordance with U.S. Laws and OFAC regulations.

Thank you. We will be in touch with any further questions.